Healthcare reform and the workplace experience of nurses: Implications for patient care and union organizing

The introduction of market-based reforms over the past twenty-five years has fundamentally changed the way healthcare is delivered in the United States. This paper reports the results of a survey of the workplace experiences and attitudes of hospital-based registered nurses under healthcare reform. The authors find that nurses who had experienced reform-related job restructuring held substantially more negative views of the climate for patient care than nurses who had not experienced restructuring. Also, nurses who had experienced reform-related mergers held more negative perceptions of the climate for patient care than those who had not been through a merger, although the relationship was less strong than it was for restructuring. Nurses concerned about a deteriorating climate for patient care indicated a desire for greater voice in the organization and staffing of hospitals and also indicated a greater readiness than other nurses to vote for a union.